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Abstract

A significant proportion of people are asymptomatic carriers of (SA), an important risk factor for the development of opportunistic infections. SA colonization is dynamic, appearing and disappearing, with strains evolving and potentially shifting in composition over time and between body sites. These changes make detection challenging, and the numerous potential sources of reintroduction from other people and even other body site reservoirs preclude efficient efforts to prevent transmission and spread. Identifying typical sources is therefore critical for mitigation. Whole-genome sequencing (WGS), ideally of multiple colonies from multiple body sites, is the gold standard for characterizing SA strains and confirming transmission. However, this is often too resource-intensive for initial assessments of transmission and not feasible for large-scale studies involving various body sites from multiple individuals over time. To address these challenges, we developed a low-cost, custom, species-specific amplicon sequencing (AmpSeq) assay optimized to provide high-resolution discrimination of SA genotypes directly from samples. We tested this approach on a subset of samples that were a part of a large-scale longitudinal study of SA carriage. Oral and nasal samples were collected from nine participants every 2 weeks for up to 18 weeks and qPCR positive samples were analysed using our AmpSeq assay directly from the sample without culturing. The longitudinal sampling strategy enabled us to characterize changes in SA colonization patterns over time, detect potential strain mixtures and identify rare variants that may serve as signatures of transmission between different body sites or among individuals. Without using WGS, we were able to rapidly eliminate the possibility of transmission between sampled residents. Participants who had positive oral and nasal samples had no fixed SNP differences between the two body sites, suggesting likely within-person spread. Analysis of rare variants segregating in the oral and nasal populations suggests that the nasal populations were the likely source of the spread because the nasal samples had higher diversity and most of the variants identified in the oral samples were shared with the nasal samples. While WGS can be used to provide higher resolution to colonization patterns and validate these findings, our AmpSeq approach offers a rapid, cost-effective, direct-from-sample method for species-specific screening intended for population-level characterization that allows researchers to strain type, identify or eliminate likely transmission cases and identify potential reservoirs before resorting to more expensive WGS methods.

Funding
This study was supported by the:
  • Arizona Biomedical Research Centre (Award CTR056052)
    • Principal Award Recipient: TaraFurstenau
  • National Institute on Minority Health and Health Disparities (Award U54MD012388)
    • Principal Award Recipient: NotApplicable
  • Centers for Disease Control and Prevention (Award 75D30121C11191)
    • Principal Award Recipient: TalimaPearson
  • Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases (Award R15AI156771)
    • Principal Award Recipient: TalimaPearson
  • Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases (Award R01AI172924)
    • Principal Award Recipient: TalimaPearson
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.
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2025-06-25
2026-03-11

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References

  1. Self WH, Wunderink RG, Williams DJ, Zhu Y, Anderson EJ et al. Staphylococcus aureus community-acquired pneumonia: prevalence, clinical characteristics, and outcomes. Clin Infect Dis 2016; 63:300–309 [View Article]
    [Google Scholar]
  2. Williams RE. Healthy carriage of Staphylococcus aureus: its prevalence and importance. Bacteriol Rev 1963; 27:56–71 [View Article] [PubMed]
    [Google Scholar]
  3. Tong SYC, Davis JS, Eichenberger E, Holland TL, Fowler VGJ. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28:603–661 [View Article] [PubMed]
    [Google Scholar]
  4. Cosgrove SE, Qi Y, Kaye KS, Harbarth S, Karchmer AW et al. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005; 26:166–174 [View Article] [PubMed]
    [Google Scholar]
  5. Hassoun A, Linden PK, Friedman B. Incidence, prevalence, and management of MRSA bacteremia across patient populations—a review of recent developments in MRSA management and treatment. Crit Care 2017; 21:211 [View Article]
    [Google Scholar]
  6. Klein EY, Jiang W, Mojica N, Tseng KK, McNeill R et al. National costs associated with methicillin-susceptible and methicillin-resistant Staphylococcus aureus hospitalizations in the United States, 2010–2014. Clinical Infectious Diseases 2019; 68:22–28 [View Article]
    [Google Scholar]
  7. Gorwitz RJ, Kruszon-Moran D, McAllister SK, McQuillan G, McDougal LK et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis 2008; 197:1226–1234 [View Article] [PubMed]
    [Google Scholar]
  8. Graham PL, Lin SX, Larson EL. A U.S. population-based survey of Staphylococcus aureus colonization. Ann Intern Med 2006; 144:318–325 [View Article] [PubMed]
    [Google Scholar]
  9. Sakr A, Brégeon F, Mège JL, Rolain JM, Blin O. An update on mechanisms, epidemiology, risk factors, and subsequent infections. Front Microbiol 2018; 9:2419 [View Article] [PubMed]
    [Google Scholar]
  10. Wertheim HFL, Melles DC, Vos MC, van Leeuwen W, van Belkum A et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005; 5:751–762 [View Article] [PubMed]
    [Google Scholar]
  11. Kluytmans J, van Belkum A, Verbrugh H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997; 10:505–520 [View Article] [PubMed]
    [Google Scholar]
  12. Lina G, Piemont Y, Godail-Gamot F, Bes M, Peter M-O et al. Involvement of Panton-Valentine leukocidin–producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis Off Publ Infect Dis Soc Am 1999; 29:1128–1132 [View Article]
    [Google Scholar]
  13. Pannaraj PS, Hulten KG, Gonzalez BE, Mason EO, Kaplan SL. Infective pyomyositis and myositis in children in the era of community-acquired, methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 2006; 43:953–960 [View Article] [PubMed]
    [Google Scholar]
  14. Reategui Schwarz E, van de Guchte A, Dupper AC, Caban AB, Nadkarni D et al. Everybody nose: molecular and clinical characteristics of nasal colonization during active methicillin-resistant Staphylococcus aureus bloodstream infection. BMC Infect Dis 2022; 22:400 [View Article] [PubMed]
    [Google Scholar]
  15. von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia: study group. N Engl J Med 2001; 344:11–16 [View Article]
    [Google Scholar]
  16. Russakoff B, Wood C, Lininger MR, Barger SD, Trotter RT et al. A quantitative assessment of Staphylococcus aureus community carriage in Yuma, Arizona. J Infect Dis 2023; 227:1031–1041 [View Article] [PubMed]
    [Google Scholar]
  17. Acton DS, Tempelmans Plat-Sinnige MJ, van Wamel W, de Groot N, van Belkum A. Intestinal carriage of Staphylococcus aureus: how does its frequency compare with that of nasal carriage and what is its clinical impact?. Eur J Clin Microbiol Infect Dis 2009; 28:115–127 [View Article]
    [Google Scholar]
  18. Piewngam P, Khongthong S, Roekngam N, Theapparat Y, Sunpaweravong S et al. Probiotic for pathogen-specific Staphylococcus aureus decolonisation in Thailand: a phase 2, double-blind, randomised, placebo-controlled trial. Lancet Microbe 2023; 4:e75–e83 [View Article] [PubMed]
    [Google Scholar]
  19. Hogan PG, Mork RL, Thompson RM, Muenks CE, Boyle MG et al. Environmental Methicillin-resistant Staphylococcus aureus contamination, persistent colonization, and subsequent skin and soft tissue infection. JAMA Pediatr 2020; 174:552–562 [View Article] [PubMed]
    [Google Scholar]
  20. Rohr U, Wilhelm M, Muhr G, Gatermann S. Qualitative and (semi)quantitative characterization of nasal and skin methicillin-resistant Staphylococcus aureus carriage of hospitalized patients. Int J Hyg Environ Health 2004; 207:51–55 [View Article] [PubMed]
    [Google Scholar]
  21. Abdulgader SM, Robberts L, Ramjith J, Nduru PM, Dube F et al. Longitudinal population dynamics of Staphylococcus aureus in the nasopharynx during the first year of life. Front Genet 2019; 10:198 [View Article] [PubMed]
    [Google Scholar]
  22. Golubchik T, Batty EM, Miller RR, Farr H, Young BC et al. Within-host evolution of Staphylococcus aureus during asymptomatic carriage. PLoS One 2013; 8:e61319 [View Article]
    [Google Scholar]
  23. Key FM, Khadka VD, Romo-González C, Blake KJ, Deng L et al. On-person adaptive evolution of Staphylococcus aureus during treatment for atopic dermatitis. Cell Host Microbe 2023; 31:593–603 [View Article] [PubMed]
    [Google Scholar]
  24. Larsen TG, Samaniego Castruita JA, Worning P, Westh H, Bartels MD. Within-host genomic evolution of methicillin-resistant Staphylococcus aureus in long-term carriers. Appl Microbiol Biotechnol 2024; 108:95 [View Article] [PubMed]
    [Google Scholar]
  25. Nilsson P, Ripa T. Staphylococcus aureus throat colonization is more frequent than colonization in the anterior nares. J Clin Microbiol 2006; 44:3334–3339 [View Article] [PubMed]
    [Google Scholar]
  26. Reiss-Mandel A, Rubin C, Maayan-Mezger A, Novikov I, Jaber H et al. Patterns and predictors of Staphylococcus aureus carriage during the first year of life: a longitudinal study. J Clin Microbiol 2019; 57:e00282-19 [View Article] [PubMed]
    [Google Scholar]
  27. Smith TC, Hellwig EJ, Wardyn SE, Kates AE, Thapaliya D. Longitudinal case series of Staphylococcus aureus colonization and infection in two cohorts of rural Iowans. Microb Drug Resist Larchmt 2018; 24:455–460 [View Article]
    [Google Scholar]
  28. Thiede SN, Snitkin ES, Trick W, Payne D, Aroutcheva A et al. Genomic epidemiology suggests community origins of healthcare-associated USA300 methicillin-resistant Staphylococcus aureus. J Infect Dis 2022; 226:157–166 [View Article] [PubMed]
    [Google Scholar]
  29. Azarian T, Daum RS, Petty LA, Steinbeck JL, Yin Z et al. Intrahost evolution of methicillin-resistant Staphylococcus aureus USA300 among individuals with reoccurring skin and soft-tissue infections. J Infect Dis 2016; 214:895–905 [View Article] [PubMed]
    [Google Scholar]
  30. Didelot X, Walker AS, Peto TE, Crook DW, Wilson DJ. Within-host evolution of bacterial pathogens. Nat Rev Microbiol 2016; 14:150–162 [View Article] [PubMed]
    [Google Scholar]
  31. Harkins CP, Pettigrew KA, Oravcová K, Gardner J, Hearn RMR et al. The microevolution and epidemiology of Staphylococcus aureus colonization during atopic eczema disease flare. J Invest Dermatol 2018; 138:336–343 [View Article] [PubMed]
    [Google Scholar]
  32. Mongkolrattanothai K, Gray BM, Mankin P, Stanfill AB, Pearl RH et al. Simultaneous carriage of multiple genotypes of Staphylococcus aureus in children. J Med Microbiol 2011; 60:317–322 [View Article] [PubMed]
    [Google Scholar]
  33. Paterson GK, Harrison EM, Murray GGR, Welch JJ, Warland JH et al. Capturing the cloud of diversity reveals complexity and heterogeneity of MRSA carriage, infection and transmission. Nat Commun 2015; 6:6560 [View Article] [PubMed]
    [Google Scholar]
  34. Votintseva AA, Miller RR, Fung R, Knox K, Godwin H et al. Multiple-strain colonization in nasal carriers of Staphylococcus aureus. J Clin Microbiol 2014; 52:1192–1200 [View Article] [PubMed]
    [Google Scholar]
  35. Muenks CE, Hogan PG, Wang JW, Eisenstein KA, Burnham C-A et al. Diversity of Staphylococcus aureus strains colonizing various niches of the human body. J Infect 2016; 72:698–705 [View Article] [PubMed]
    [Google Scholar]
  36. Lindsay JA. Genomic variation and evolution of Staphylococcus aureus. Int J Med Microbiol 2010; 300:98–103 [View Article]
    [Google Scholar]
  37. McCarthy AJ, Loeffler A, Witney AA, Gould KA, Lloyd DH et al. Extensive horizontal gene transfer during Staphylococcus aureus co-colonization in vivo. Genome Biol Evol 2014; 6:2697–2708 [View Article] [PubMed]
    [Google Scholar]
  38. von Wintersdorff CJH, Penders J, van Niekerk JM, Mills ND, Majumder S et al. Dissemination of antimicrobial resistance in microbial ecosystems through horizontal gene transfer. Front Microbiol 2016; 7:173 [View Article]
    [Google Scholar]
  39. Hall MD, Holden MT, Srisomang P, Mahavanakul W, Wuthiekanun V et al. Improved characterisation of MRSA transmission using within-host bacterial sequence diversity. Elife 2019; 8:e46402 [View Article] [PubMed]
    [Google Scholar]
  40. Pearson T, Furstenau T, Wood C, Rigas V, Sahl J et al. Population sequencing for diversity and transmission analyses. bioRxiv 20242024.06.18.599478 [View Article] [PubMed]
    [Google Scholar]
  41. Enright MC, Day NPJ, Davies CE, Peacock SJ, Spratt BG. Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol 2000; 38:1008–1015 [View Article]
    [Google Scholar]
  42. O’Leary NA, Wright MW, Brister JR, Ciufo S, Haddad D et al. Reference sequence (RefSeq) database at NCBI: current status, taxonomic expansion, and functional annotation. Nucleic Acids Res 2016; 44:D733–D745 [View Article]
    [Google Scholar]
  43. Kurtz S, Phillippy A, Delcher AL, Smoot M, Shumway M et al. Versatile and open software for comparing large genomes. Genome Biol 2004; 5:R12 [View Article] [PubMed]
    [Google Scholar]
  44. Sahl JW, Lemmer D, Travis J, Schupp JM, Gillece JD et al. NASP: an accurate, rapid method for the identification of SNPs in WGS datasets that supports flexible input and output formats. Microb Genom 2016; 2:e000074 [View Article] [PubMed]
    [Google Scholar]
  45. Joglekar P, Conlan S, Lee-Lin S-Q, Deming C, Kashaf SS et al. Integrated genomic and functional analyses of human skin-associated Staphylococcus reveal extensive inter- and intra-species diversity. Proc Natl Acad Sci U S A 2023; 120:e2310585120 [View Article] [PubMed]
    [Google Scholar]
  46. Kloos WE, Schleifer KH. Isolation and characterization of staphylococci from human skin II: descriptions of four new species: Staphylococcus warneri, Staphylococcus capitis, Staphylococcus hominis, and Staphylococcus simulans. Int J Syst Evol Microbiol 1975; 25:62–79 [View Article]
    [Google Scholar]
  47. Saber H, Jasni AS, Tengku Jamaluddin TZM, Ibrahim R et al. A review of staphylococcal cassette chromosome mec (SCC* mec*) types in coagulase-negative Staphylococci (CoNS) species. Malays J Med 2017; 24:7–18 [View Article]
    [Google Scholar]
  48. Furstenau TN, Cocking JH, Sahl JW, Fofanov VY. Variant site strain typer (VaST): efficient strain typing using a minimal number of variant genomic sites. BMC Bioinform 2018; 19:222 [View Article] [PubMed]
    [Google Scholar]
  49. Wick RR, Holt KE. rrwick/Assembly-Dereplicator: assembly Dereplicator v0.1.0 2019. https://doi.org/10.5281/zenodo.3365572
  50. Nguyen L-T, Schmidt HA, von Haeseler A, Minh BQ. IQ-TREE: a fast and effective stochastic algorithm for estimating maximum-likelihood phylogenies. Mol Biol Evol 2015; 32:268–274 [View Article] [PubMed]
    [Google Scholar]
  51. Croucher NJ, Page AJ, Connor TR, Delaney AJ, Keane JA et al. Rapid phylogenetic analysis of large samples of recombinant bacterial whole genome sequences using Gubbins. Nucleic Acids Res 2015; 43:e15 [View Article] [PubMed]
    [Google Scholar]
  52. Minh BQ, Nguyen MAT, von Haeseler A. Ultrafast approximation for phylogenetic bootstrap. Mol Biol Evol 2013; 30:1188–1195 [View Article] [PubMed]
    [Google Scholar]
  53. Bogdanowicz D, Giaro K, Wróbel B. TreeCmp: comparison of trees in polynomial time. Evol Bioinform 2012; 8: [View Article]
    [Google Scholar]
  54. Galili T. dendextend: an R package for visualizing, adjusting and comparing trees of hierarchical clustering. Bioinformatics 2015; 31:3718–3720 [View Article]
    [Google Scholar]
  55. Barger SD, Lininger MR, Trotter RT, Mbegbu M, Kyman S et al. Cross-sectional study of the association of social relationship resources with Staphylococcus aureus colonization in naturally occurring social groups along the US/Mexico border. PLoS One 2023; 18:e0284400 [View Article]
    [Google Scholar]
  56. Barger SD, Lininger MR, Trotter RT 2nd, Wayment HA, Mbegbu M et al. Educational attainment and Staphylococcus aureus colonization in a Hispanic border community: testing fundamental cause theory. mSphere 2020; 5:e00623-20 [View Article] [PubMed]
    [Google Scholar]
  57. Pearson T, Barger SD, Lininger M, Wayment H, Hepp C et al. Health disparities in Staphylococcus aureus transmission and carriage in a border region of the United States based on cultural differences in social relationships: protocol for a survey study. JMIR Res Protoc 2019; 8:e14853 [View Article] [PubMed]
    [Google Scholar]
  58. Pearson T, Hepp C, Trotter RT II, Mbegbu M, Russakoff B et al. Genome sequences of community carriage strains of Staphylococcus aureus from Yuma, Arizona. Microbiol Resour Announc 2021; 10:e0044921 [View Article]
    [Google Scholar]
  59. Martin M. Cutadapt removes adapter sequences from high-throughput sequencing reads. EMBnet J 2011; 17:10 [View Article]
    [Google Scholar]
  60. Bolger AM, Lohse M, Usadel B. Trimmomatic: a flexible trimmer for illumina sequence data. Bioinformatics 2014; 30:2114–2120
    [Google Scholar]
  61. Li H. Aligning sequence reads, clone sequences and assembly contigs with BWA-MEM. arXiv 2013 [View Article]
    [Google Scholar]
  62. Li H, Durbin R. Fast and accurate short read alignment with Burrows–Wheeler transform. Bioinformatics 2009; 25:1754–1760 [View Article]
    [Google Scholar]
  63. Li H. A statistical framework for SNP calling, mutation discovery, association mapping and population genetical parameter estimation from sequencing data. Bioinformatics 2011; 27:2987–2993 [View Article]
    [Google Scholar]
  64. Wood C, Sahl J, Maltinsky S, Coyne B, Russakoff B et al. SaQuant: a real-time PCR assay for quantitative assessment of staphylococcus aureus. BMC Microbiol 2021; 21:174
    [Google Scholar]
  65. Wilm A, Aw PPK, Bertrand D, Yeo GHT, Ong SH et al. LoFreq: a sequence-quality aware, ultra-sensitive variant caller for uncovering cell-population heterogeneity from high-throughput sequencing datasets. Nucleic Acids Res 2012; 40:11189–11201 [View Article] [PubMed]
    [Google Scholar]
  66. Nei M. Genetic distance between populations. Am Nat 1972; 106:283–292 [View Article]
    [Google Scholar]
  67. Zhou Z, Alikhan N-F, Sergeant MJ, Luhmann N, Vaz C et al. GrapeTree: visualization of core genomic relationships among 100,000 bacterial pathogens. Genome Res 2018; 28:1395–1404 [View Article]
    [Google Scholar]
  68. Jolley KA, Maiden MCJ. BIGSdb: Scalable analysis of bacterial genome variation at the population level. BMC Bioinformatics 2010; 11:595 [View Article] [PubMed]
    [Google Scholar]
  69. Seemann T. mlst; 2022 https://github.com/tseemann/mlst
  70. Wilgenbusch JC, Swofford D. Inferring evolutionary trees with PAUP. Curr Protoc Bioinforma 2003; 6:6 [View Article]
    [Google Scholar]
  71. Tonkin-Hill G, Ling C, Chaguza C, Salter SJ, Hinfonthong P et al. Pneumococcal within-host diversity during colonization, transmission and treatment. Nat Microbiol 2022; 7:1791–1804 [View Article] [PubMed]
    [Google Scholar]
  72. Kalmeijer MD, van Nieuwland-Bollen E, Bogaers-Hofman D, de Baere GA. Nasal carriage of Staphylococcus aureus is a major risk factor for surgical-site infections in orthopedic surgery. Infect Control Hosp Epidemiol 2000; 21:319–323 [View Article] [PubMed]
    [Google Scholar]
  73. Kluytmans JA, Mouton JW, Ijzerman EP, Vandenbroucke-Grauls CM, Maat AW et al. Nasal carriage of Staphylococcus aureus as a major risk factor for wound infections after cardiac surgery. J Infect Dis 1995; 171:216–219 [View Article] [PubMed]
    [Google Scholar]
  74. Reagan DR, Doebbeling BN, Pfaller MA, Sheetz CT, Houston AK et al. Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. Ann Intern Med 1991; 114:101–106 [View Article] [PubMed]
    [Google Scholar]
  75. Guérillot R, Li L, Baines S, Howden B, Schultz MB et al. Comprehensive antibiotic-linked mutation assessment by resistance mutation sequencing (RM-seq). Genome Med 2018; 10:63 [View Article] [PubMed]
    [Google Scholar]
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